Ocular explosions from periocular anesthetic injections

Ocular complications of perioperative anesthesia: a review

Ocular complications associated with anesthesia in ocular and non-ocular surgeries are rare adverse events which may present with clinical presentations vacillating between easily treatable corneal abrasions to more serious complication such as irreversible bilateral vision loss. In this review, we outline the different techniques of anesthetic delivery in ocular surgeries and highlight the incidence and etiologies of associated injuries. The changes in vision in non-ocular surgeries are mistaken for residual sedation or anesthetics, therefore require high clinical suspicion on part of the treating ophthalmologists, to ensure early diagnosis, adequate and swift management especially in surgeries such as cardiac, spine, head and neck, and some orthopedic procedures, that have a comparatively higher incidence of ocular complications. In this article, we review the literature for reports on the clinical incidence of different ocular complications associated with anesthesia in non-ocular surgeries and outline the current understanding of pathophysiological processes associated with these adverse events.

Displacement of crystalline lens into the sub-conjunctival space following periocular anesthesia

A 65-year-old female presented with loss of vision and a mass in her right eye after periocular anaesthesia for cataract surgery in a camp. She was found to have a nasal subconjunctival mass, which was confirmed to contain the crystalline lens after surgical exploration, along with a superior perilimbal suspected scleral rupture. There was accompanying vitreous haemorrhage, retinal detachment and subretinal haemorrhage that was managed by pars plana vitrectomy. Post operatively, she achieved a best corrected visual acuity of 20/80 that was maintained till 6 months follow up. Globe rupture and subconjunctival lens extrusion in the setting of inadvertent globe penetration during periocular anesthesia is a rare complication. In the absence of medical records pertaining to the primary event, this clinical presentation posed a diagnostic challenge. Timely and appropriate management led to an acceptable visual and anatomical outcome in this unfortunate and devastating scenario.